Affiliations: Section of Epilepsy and Sleep Disorders, Department of
Neurology, School of Medicine, Celal Bayar University, Manisa, Turkey
Note: [] Corresponding author: Hikmet Yilmaz, MD, Associate Professor,
Celal Bayar University, School of Medicine, Department of Neurology, Epilepsy
and Sleep, Disorders Section, Manisa, Turkey. Tel.: +90 2362323133/291 and 218;
Fax: +90 2362370213; E-mail: yilmazhikmet@hotmail.com
Abstract: Purpose: Levetiracetam-treated patients commonly report daytime
drowsiness, fatique, asthenia and decreasing of motor activity. However the
origin of these reported side effects are still debated, we aimed to clarify
effect of levetiracetam on sleep. Therefore this prospective study was
conducted to evaluate the effects of levetiracetam on motor activity, amount
and continuity of sleep and napping. Methods: Various tests were
performed on twenty two patients treated with levetiracetam (10 monotherapy, 12
add-on therapy) at least three days before the initiation of treatment, and
consecutively for five to eight days at the third week of treatment. These
tests included sleep logs, Pittsburgh Sleep Quality Index, Epworth Sleepiness
Scale, Modified Maintenance of Wakefulness Test and actimetric measurements. In
order to evaluate the sleep behavior of these patients the following sleep
parameters were estimated: bedtime, wake-up time, sleep-onset time,
sleep-offset time, sleep latency, total sleep time, wake time after sleep
onset, fragmentation index, total activity score, nap episodes, total nap
duration and sleep efficiency. Twenty members of staff from our hospital
(Doctor, nurse, secretary, civil servant etc.) were evaluated as control
subjects in the study. Results: After three-week treatment with
levetiracetam (in particular with add-on therapy), Epworth Sleepiness Scale
scores, napping episodes and total nap durations increased and sleep latencies
decreased. While durations of Modified Maintenance of Wakefulness Test and
total activity scores decreased. However the total sleep time and the sleep
efficiency did not show any difference from the pre-treatment values. Conclusions: Our results suggest that levetiracetam leads to drowsiness by
decreasing the daily motor activity and increasing the naps; however this agent
does not have any major effects on total sleep time and sleep efficiency during
night. Actimetric analyses give information about continuity of sleep and
sleep/wake states however does not give satisfactory information about
architecture of sleep. In order to determine the effects of levetiracetam on
the sleep architecture we need similiar protocol studies by full night
polysomnography.
Keywords: Actimeter, levetiracetam, nap episodes, total activity score, drowsiness, sleep efficiency
